Health & Wellness

The Truth About Hormones: A Friendly Guide For Women

By: Brett A. Osborn, DO, FAANS, CSCS

Remember how great you felt when you were 18? Your mind was clear, your attitude carefree, and you were ready to take on the world. You were motivated and full of enthusiasm… You were bursting with energy and were far stronger, leaner, and mentally sharper than you are now. You wish you had that back, right? Who doesn’t? What happened to all that vim and vigor?

Life happened. While we cannot prevent the body from aging, we can thwart the process to some degree. While there is undoubtedly a genetic component to aging, it is likely related to the accumulation of metabolic by-products within our cells, much like oil residue within our car’s cylinders. Everything you do puts mileage on the odometer. That’s why aging is inescapable! But good nutrition and foods loaded with antioxidants will quench those free radicals formed during meals, hindering the aging process. Exercise also bolsters antioxidant status. Exercise not only makes you look great but feel great, likely due to its direct effect on one’s neurotransmitter levels and the restoration of more youthful hormone profile. But over time, and despite your best efforts, hormone levels often decrease leading to a variety of issues that are ascribed to ‘just getting old.’ But there’s a solution: Hormone Replacement Therapy or HRT.

When Should a Woman Start HRT?

One of the first questions I often hear is, “When should I start HRT?” Generally, women should begin considering HRT when they start experiencing menopausal symptoms, which typically occurs between the ages of 45 and 55. However, it’s not just about age; it’s about the symptoms and how they affect your quality of life. Some women might need to start earlier or later, depending on their unique situations. It’s crucial to consult with a healthcare provider to determine the best timing for you. I often start my younger patients on bioidentical progesterone in isolation to combat insomnia, elevate mood and minimize menstrual irregularities that often begin between ages 35 and 40. Remember, progesterone – not estrogen, as is commonly believed – is the first hormone to decrease as you approach menopause. 

Recognizing the Need for HRT: Symptoms to Watch For

How do you know if you should consider HRT? Menopause brings a variety of symptoms, and some can be quite disruptive. Hot flashes, night sweats, mood swings, vaginal dryness, and even decreased bone density are common signs that might suggest the need for HRT. If these symptoms are significantly impacting your daily life, it might be time to have a conversation with your doctor about HRT. As alluded to above though, many women develop symptoms of hormone deficiency in their mid-30’s. And these symptoms may be more subtle, so a high index of suspicion is key.

Monitoring Hormone Levels: The Role of Blood Work

Once you decide to start HRT, monitoring your hormone levels is an essential part of the process. Blood work is typically done before starting HRT to establish a baseline. After beginning treatment, follow-up blood tests are usually recommended every 3 to 6 months to ensure your hormone levels are where they need to be and to make any necessary adjustments to your therapy. This monitoring can be tailored based on your individual response and any side effects you might experience.

Choosing the Right Facility for HRT

Selecting the right facility for HRT is a crucial step. You want to ensure that you’re in good hands. Here are some tips to help you make the best choice:

 • Qualifications and Experience: Look for healthcare providers who are experienced in managing menopause and HRT. Your physician must be Board-Certified in his or her chosen profession and should have a secondary certification from the American Academy of Anti-Aging Medicine (A4M). 

• Comprehensive Care: Find facilities that offer a holistic approach, including lifestyle and dietary advice alongside HRT. Steer clear of ‘hormone clinics,’ therefore. Many are operated by non-qualified individuals without a medical license – and unbeknownst to the patients.

• Reputation and Reviews: Check reviews and seek recommendations from other patients.

• Personalized Treatment: Opt for a facility that tailors the treatment plan to your specific needs and monitors your progress closely. HRT must be ‘customized’ to you – in the context of your goals. Remember, your biochemistry is different than your girlfriend’s. HRT is not a one-size, fits-all.

The Benefits of Starting HRT Early

Many women wonder if starting HRT earlier can help ease the transition through menopause. The answer is often yes. Beginning HRT during the perimenopausal phase can manage symptoms more effectively, potentially leading to a smoother transition. HRT can reduce the severity of menopausal symptoms, giving much-needed relief and improving your quality of life.

The Benefits of HRT

HRT offers a range of benefits that can make a significant difference in your daily life:

• Symptom Relief: HRT can be used to alleviate common menopausal symptoms such as hot flashes, night sweats, mood swings, and vaginal dryness.

• Improved Sleep Quality: By reducing night sweats and other disruptive symptoms, HRT can help improve your sleep.

• Enhanced Quality of Life: Many women find that HRT helps stabilize their mood and overall sense of well-being.

• Bone Health: HRT can prevent osteoporosis and reduce the risk of fractures.

• Potential Cancer Risk Reduction: Some studies suggest that HRT may reduce the risk of colon cancer.

Understanding the Risks and Side Effects of HRT

While HRT has many benefits, it’s also important to be aware of the potential risks and side effects. Some of the risks include:

• Blood Clots and Stroke: HRT can increase the risk of blood clots and stroke; however, this is typically associated with the use of synthetic, non-bioidentical hormones. Synthetic preparations are, therefore, are never used in my longevity clinic. This similarly applies to breast cancer.

• Breast Cancer: Long-term use of synthetic HRT has been associated with an increased risk of breast cancer according to the WHI study. Again, this does not apply to those using bioidentical hormones to which your body has been exposed since menarche. Else, there would be a very high incidence of breast cancer in teenagers – when hormone levels are peaking.

• Side Effects: Some women experience side effects such as bloating, breast tenderness, headaches, and mood changes. These side effects can be minimized and/or easily managed by an experienced physician. 

It’s essential to weigh these risks against the benefits and discuss them with your healthcare provider to make an informed decision that suits your health needs and lifestyle.

Conclusion: Making the Decision

Deciding whether to start HRT is a personal choice and one that should be made with thorough understanding and professional guidance. As you consider your options, remember that your physician and healthcare team is there to help you navigate this process, answer your questions, and tailor a plan that works best for you.

HRT can be a powerful tool in managing the symptoms of menopause and improving your quality of life. By staying informed and working closely with your healthcare team – who should not only be routinely interacting with you during your healthcare journey but also checking bloodwork several times throughout the year – you can make the best decision for your health and well-being. Summarily speaking, HRT carries with it low risk and potentially can prove transformative to your health and quality of life.

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